Engine Failure Of Flight 191 Engineering Essay

Engine Failure Of Flight 191 Engineering EssayThe exit of the locomotive by itself should not assume been affluent to curtilage the accident.12 Flight 191 would go for been perfectly capable of re upriseing to the airport development its remaining two locomotives, as the DC-10 is capable of staying airborne with any genius locomotive engine out of operation. However, several other factors combined to pay off a catastrophic loss of control.The engine breakup had severed the hydraulic lines that cont pile uped the aircrafts leading-edge wing furnishs (retractable devices that belittle a wings point of view speed during pasquinade and landing). The damage to the lines caused a loss of hydraulic pressure, which in turn take to uncommanded retraction of the outboard slats in the left wing.1 Unlike other aircraft invents, the DC-10 did not include a separate mechanism to lock the slats in place.1Investigators examined the flight data recorder (FDR) and conducted wind turn everywhere tests and flight simulator tests to understand the trajectory of flight 191 after the engine detached and the slats retracted. These tests established that the damage to the wing leading edge and retraction of the slats increased the sales booth speed of the left wing from 124kt to 159kt.1Comparison of the FDR data and the simulator tests showed that the pilots of flight 191 had followed the action for engine failure at take-off. This procedure called for the captain to go to VHYPERLINK http//en.wikipedia.org/wiki/V_SpeedsOther_reference_speeds2 (standard preventative takeoff speed) which for flight 191 was 153kt, 6kt below the stall speed.1 At the cartridge clip the engine fell off the aircraft, flight 191 was already travelling at 165kt, safely above the stall speed. Thus, by slowing the aircraft to 153kt in accordance with the emergency procedure, the pilots inadvertently induced the stall which proved fatal. Following this accident, McDonnell Douglas revised the procedure, advising that if the aircraft was already flying faster than V2 sum total 10kt the pilots should maintain a margin of 10kt above V2.1The DC-10 incorporates two warning devices which might have alerted the pilots to the impending stall the slat disagreement warning light which should have illuminated after the uncommanded retraction of the slats, and the stall warning system (stick-shaker) which activates close to the stall speed. Unfortunately, both of these warning devices were powered by an electric generator goaded by the no. 1 engine following the loss of that engine, they both became inoperative.1edit Engine separationAn FAA diagram of the DC-10 engine and power pylon assembly indicating the failed aft pylon attach fitting.From an examinaton of the detached engine, the NTSB concluded that the pylon attachment had been damaged before the belt.1 Investigators looked at the planes alimony history and found that its most recent service was octonary weeks before the crash, in which engine number one had been removed from the aircraft, however the pylon, the rigging holding the engine onto the wing, had been damaged during the procedure. The original procedure called for removal of the engine prior to the removal of the engine pylon, but American Airlines had begun to use a procedure that saved approximately 200 man-hours per aircraft and more importantly from a prophylactic standpoint, it would reduce the number of disconnects (i.e., hydraulic and fuel lines, electrical cables, and wiring) from 72 to 27.1The new procedure involved mechanics removing the engine with the pylon as one unit, sort of than the engine, and then the pylon. A expectant forklift was used to support the engine while it was being detached from the wing a procedure that was found to be extremelly fractious to execute successfully, due to backbreakingies with holding the engine assembly on-key while it was being removed.The field service representative from the manufac turer, McDonnell-Douglas, said it would not encourage this procedure due to the element of risk and had so advised American. However, McDonnell-Douglas does not have the authority to either approve or disapprove the maintenance procedures of its customers.1The accident investigating to a fault concluded that the physique of the pylon and adjacent surfaces made the parts difficult to service and prone to damage by maintenance crews. The NTSB reported that on that point were two different approaches to the one-step procedure using an overhead hoist or using a forklift. United Airlines used a hoist American and Continental Airlines used a forklift. According to the NTSB, all the cases wherein impact damage was sustained and cracks found involved the use of the forklift.1Under the procedure American used, if the forklift was in the wrong position, the engine would rock like a see- power saw and jam against the pylon attachment points. The forklift operator was guided by hand and voic e signals the position had to be spot-on or could cause damage. Management was aware of this. The modification to the aircraft involved in Flight 191 did not go smoothly. Engineers started to disconnect the engine and pylon, but changed slant middle(a) through. When work continued, the pylon was jammed on the wing and the forklift had to be repositioned. This was important evidence because, in order to disconnect the pylon from the wing, a bolt had to be removed so that the flange could strike the clevis. The procedure used caused an indentation that damaged the clevis pin assembly and created an indentation in the trapping of the self-aligning bearing, which in turn weakened the structure sufficiently to cause a small stress fracture. The fracture went unnoticed for several flights, getting worse with individually flight. During Flight 191s takeoff, affluent force was generated to finally cause the pylon to fail. At the point of rotation, the engine detached and was flipped ov er the top of the wing.edit ConclusionThe findings of the probe by the field of study merchant vessels Safety Board (NTSB) were released on December 21, 19791The National Transportation Safety Board determines that the probable cause of this accident was the asymmetrical stall and the ensuing roll of the aircraft because of the uncommanded retraction of the left wing outboard leading edge slats and the loss of stall warning and slat disagreement indication systems subjecting from maintenance-induced damage leading to the separation of the No. 1 engine and pylon assembly at a critical point during takeoff. The separation resulted from damage by improper maintenance procedures which led to failure of the pylon structure.Contributing to the-cause of the accident were the vulnerability of the design of the pylon attach points to maintenance damage the vulnerability of the design of the leading edge slat system to the damage which produced asymmetry deficiencies in Federal Aviation A dministration surveillance and reporting systems which failed to detect and prevent the use of improper maintenance procedures deficiencies in the practices and communications among the operators, the manufacturer, and the FAA which failed to determine and disseminate the particulars regarding previous maintenance damage incidents and the intolerance of prescribed operational procedures to this unique emergency.The NTSB determined that the damage to the left wing engine pylon had occurred during an primitively engine change at the American Airlines aircraft maintenance facility in Tulsa, Oklahoma on March 29 and 30, 1979.1 The evidence came from the flange, a critical part of the pylon assembly.edit effectFirst responders survey the Flight 191 crash site in Des Plaines, Illinois.Problems with DC-10s were discovered as a cause of the accident, including deficiencies in both design specifications and maintenance procedures which made damage very likely. In response to this incident, American Airlines was fined by the United States government $500,000 for improper maintenance procedures12.Two weeks after the accident, on June 6, the FAA ordered all DC-10s to be grounded until all problems were solved. The ban was lifted on July 13.13The crash of another DC-10 in November 1979, Air impertinent Zealand Flight 901, would only add to the DC-10s negative reputation at the time however, Flight 901 was caused by several human and environmental factors not related to the airworthiness of the DC-10, and the aircraft was later completely exonerated in that accident. Although McDonnell Douglas employees participated in an Im proud of the DC-10 campaign, the companys shares fell more than 20% following the crash of Flight 191. In 1997, the McDonnell Douglas company was taken over by its rival, Boeing.Despite the safety concerns, the DC-10 went on to outsell its closest competitor, the Lockheed L-1011 TriStar, by nearly 2 to 1. This was due to the L-1011s launch being de layed, the introduction of the DC-10-30 long setting model without a competing TriStar variant, and the DC-10 having a greater choice of engines (the L-1011 was only useable with Rolls-Royce engines, while the DC-10 could be ordered with General Electric or Pratt HYPERLINK http//en.wikipedia.org/wiki/Pratt__WhitneyHYPERLINK http//en.wikipedia.org/wiki/Pratt__Whitney Whitney engines). The DC-10 program also benefited from obtaining a U.S. Air Force contract to develop a long-range refueller, which culminated in the KC-10 Extender. Lockheed had no such support for the TriStar, and halted production in 1982.NTSB investigationThe crash of flight 191 brought fierce criticism from the media because it was the fourth fatal accident involving a DC-10 at the time. Six hundred and twenty-two people had died in DC-10 accidents, including flight 191. As the weather was perfect for flying and there was no indication that a flock of birds or another plane caused the crash, the remains of engine 1 raised(a) serious concerns of the safety of the DC-10. The separated engine was not the only concern, as the public wanted to know whether the detached engine was the only cause of the crash. Investigators wondered if a fire was possibly the cause, as this was backed up by testimony from air traffic controller Ed Rucker who said he saw a flash from the wing. This raised concerns that 191 was the result of a terrorist attack. Sixty witnesses who saw the plane on the run dash ruled out a bomb, as they all saw engine 1 swing forward then flip up and over the top of the wing, which pointed to structural failure as the cause.The findings of the investigation by the National Transportation Safety Board (NTSB) were released on December 21, 1979. It revealed the probable cause to be attributable to damage to the left wing engine pylon that occurred during an earlier engine change at American Airliness aircraft maintenance facility in Tulsa, Oklahoma on March 29 and 30, 1979. cite web url =http//amelia.db.erau.edu/reports/ntsb/aar/AAR79-17.pdf human activity=NTSB (National Transportation Safety Board) Report Evidence came from the flange, a critical part of the pylon assembly. It was revealed to be damaged before the crash, and investigators looked at the planes maintenance history and found it was serviced 8 weeks before the crash. The pylon was damaged due to an ill-thought-out engine removal procedure. The original procedure called for removal of the engine prior to the removal of the engine pylon. To save time and costs, American Airlines, without the approval of McDonnell Douglas, had begun to use a faster procedure. They instructed their mechanics to remove the engine with the pylon all together as one unit. A large forklift was used to support the engine while it was being detached from the wing. This procedure was extremely difficult to execute successfully, due to difficulties with holding the engine assembly straight while it was being removed.This method of engine-pylon removal was used to save man hours and was encouraged despite differences with the manufacturers specifications on how the procedure was supposed to be performed. The accident investigation also concluded that the design of the pylon and adjacent surfaces made the parts difficult to service and prone to damage by maintenance crews. According to the account Channel,cite videotitle = The Crash of Flight 191url = http//store.aetv.com/html/product/index.jhtml?id=71451publisher = The History Channelpublisherid = AAE-71451medium = DVD United Airlines and Continental Airlines were also using a one-step procedure. After the accident, cracks were found in the bulkheads of DC-10s in both fleets.The procedure used for maintenance did not proceed smoothly. If the forklift was in the wrong position, the engine would rock like a see-saw and jam against the pylon attachment points. The forklift operator was guided by hand and voice signals the position had to be spot-on or could c ause damage, but management was unaware of this. The modification to the aircraft involved in flight 191 did not go smoothly orchestrates started to disconnect the engine and pylon but changed shift halfway through when work continued, the pylon was jammed on the wing and the forklift had to be re-positioned. This was important evidence because, in order to disconnect the pylon from the wing, a bolt had to be removed so that the flange could strike the clevis. The procedure used caused an indentation that damaged the clevis pin assembly and created an indentation in the housing of the self-aligning bearing, which in turn weakened the structure sufficiently to cause a small stress fracture. The fracture went unnoticed for several flights, getting worse with each flight that the plane had taken. During flight 191s takeoff, enough force was generated to finally cause the pylon to fail. At the point of rotation, the engine detached and was flipped over the top of the wing.The loss of t he engine by itself should not have been enough to cause the accident. During an interview on Seconds From Disaster, Former NTSB investigator Michael Marx mentioned there were other incidents where the engine fell off, insofar they landed without incident. Flight 191 would have been perfectly capable of returning to the airport using its remaining two engines, as the DC-10 is capable of staying airborne with any integrity engine out of operation. Unfortunately, several other factors combined to cause a catastrophic loss of control.The separation of the engine severed electrical wiring and hydraulic lines which were routed through the leading edge of the wing. The damage to the lines caused a loss of hydraulic pressure, which in turn led to uncommanded retraction of the outboard slats in the port wing. The DC-10 design included a back-up hydraulic system which should have been enough to keep the slats in place however, both lines are too close together, a design also used on the DC -9. There should have been enough fluid to keep the slats extended, so investigators wanted to know why they were never re-extended by the pilot. The dissolve came from the end of the recording on the CVR. The number 1 engine powered both the recorder and the slat warning system, which left the pilot and co-pilot with no way of knowing or so the position of the slats. Investigators examined the FDR to see what occurred after the engine detached. The procedure called for the captain to go to V2 which he did perfectly, but investigators found that it said nothing about incidents where the speed was already above V2, as it was in this case. Therefore, the pilot had to reduce speed. Simulator tests were done to see if this made a difference 13 pilots followed the procedure 70 times and not one was able to recover. The NTSB concluded that reducing speed when the slats are back may actually have made it more difficult for the pilot to recover control of the aircraft. When a DC-10 is abo ut to stall it gives two warnings The introductory is the stick-shaker which causes the yoke to vibrate, and the second is a warning light that flashes. These combined warnings should have alerted the pilots to increase speed immediately. American Airlines had chosen to have the stick-shaker on the pilots side only, but the stick-shaker did not operate because it was powered by the missing left engine. In the event of an engine failure, it is possible for the flight engineer to switch the pilots controls to a backup power supply. However, investigators determined that in order for him to access the necessary switch, the engineer would have had to unfasten his seat belt, stand up, and turn around.The DC-10 hit the ground with a bank of 112, and at a nose-down attitude of 21. The NTSB concluded that given the circumstances of the situation, the pilots could not be reasonably blamed for the resulting accident.In his book Blind Trust, cite book title = Blind Trust last=Nance first= John J. authorlink=John J. Nance publisher = William Morrow Co isbn = 0-688-05360-2 year = 1987 John J. Nance argues that the 1978 Airline Deregulation Act caused havoc and induced cost-cutting in the industry, producing a serious erosion of the margin of safety for passengers. Nance argues that the industry reverted from an industry under partial surveillance to an industry running on the honor system.AftermathProblems with DC-10s were discovered as a cause of the accident, including deficiencies in both design specifications and maintenance procedures which made damage very likely. Since the crash happened just before a Western Airlines DC-10 crashed in Mexico City and five years after a Turkish Airlines DC-10 crashed near Paris, the FAA quickly ordered all DC-10s to be grounded until all problems were solved. The result of the problem-solving was an arguably more efficient and safe DC-10.The US government fined American Airlines $500,000 for improper maintenance procedures, but the insurance settlement for the replacement of the aircraft gave American Airlines $25,000,000 beyond the amount of the fine.Factdate=June 2007Although the companys employees participated in an Im proud of the DC-10 campaign, McDonnell Douglas shares fell more than 20% following the crash of Flight 191. The DC-10 itself had a bad reputation, but ironically it was very much caused by poor maintenance procedures, and not design flaw. In 1997 the McDonnell Douglas company was taken over by its rival, Boeing, which moved its corporate headquarters from Seattle to Chicago.Despite the safety concerns, the DC-10 went on to outsell its closest competitor, the Lockheed L-1011, by nearly 2 to 1. This was due to the L-1011s launch being delayed and the DC-10 having a greater choice of engines (the L-1011 was only available with Rolls-Royce engines, while the DC-10 could be ordered with General Electric or Pratt Whitney engines).

Gated DIBH for Left Sided Breast Cancer Patients

Gated DIBH for Left Sided Breast Cancer tolerantsChapter III Methodology3.1 investigate ObjectivesThe query project examines leftfield-sided breast crabby person unhurrieds receiving therapy with gated DIBH technique use the commercially avail equal revolutions per minute system. The primary objective of this interrogation is to evaluate whether left-sided breast preemptcer patients will benefit from gated DIBH. The interest in per social classing this research arises from having many left-sided breast genus Cancer patients that constitute large volume of heart in the treatment field, and hence are at risk for cardiac toxicities in the prox. The secondary objectives of this research is to look at patients comfort and understanding, and shaft healers workload. This chapter will discuss the exemplification selection, ethical issues, instrumentation, information collection procedures, data analysis, limitations, expected results, budget and prison termline.3.2 Sample selection and descriptionThe expected take in size was careful utilise the formula (Chan, 2003) for paired samples as seen below,Total sample size = where c is 10.5 for 90% power, is the standardised effect size, given by the formula (Chan, 2003)where 1 and 2 are the means of the two treatment groups, and is the common standard deviation.The 90% power represents the probability of rejecting the null hypothesis when it is bogus (Chan, 2003). It is postulated that a good treatment contrariety () between the 2 groups is 0.2 units with an SD () of 0.5 units (Chan, 2003). With these values, the expected sample size is 68.Sixty-eight left-sided breast scum bagcer patients will be selected for this research utilise a simple random sampling method. The patient population will be chosen at random to create a divers(prenominal) group of patients with variable breast and heart volumes.The criteria for this sample would be female patients with left-sided breast cancer below the age of 7 0. In addition, the patients must be able to generate their breath. These patients will be recruited after being screened by the oncologists. The oncologists will do a simple breath-hold test with patients to make up if they are able to hold their breath for at least 20 seconds. This is because patients will be postulate to hold their breath during the CT scan for a duration of 18 seconds.This research will require 2 sets of computed-tomography (CT) scans from each patient of which one is at free breathing and the other at DIBH. Both sets will have undistinguishable patient setup. Patients will be lying supine with both arms above head on a posirest, having the visual goggles on (see auxiliary M, image A) with a 6-reflective markers block on patients anterior abdominal surface (see Appendix H). With the goggles, they are able to view the screen, as seen in image B in Appendix M, in order to see their breathing patterns. For each patient, 2 treatment excogitations will be gener ated one utilise the CT images at free breathing with photon electron suffer technique and the other using the CT images at DIBH with gated DIBH technique using RPM with 3-mm intervals.3.3 honest Issues and Informed consentAny research involving human subjects conducted in the hospital would require adherence to ethical standards. The procedure requires the collation of a list of investigators in the department that intends to conduct clinical trials (see Appendix N), and to apply and attend the Singapore Guideline for Good Clinical Practice (SGGCP) course. This Course ensures that the conduct of clinical trials follows internationally acceptable ethical and scientific standards (see Appendix O). The ethics review will be carried out by the National Healthcare Group domain specialized review board which is an independent committee constituted of medical, scientific and non-scientific members, whose responsibility is to ensure the protection of the rights, safety and head-being of human subjects involved in a research study by reviewing, approving and providing continuing review of research studies, and of the methods and materials to be used in obtaining and documenting sensible consent of the research subjects (National University Health System, 2010). When a principal investigator submits an application via the research online administration and management system, it is automatically routed to the department representative for endorsement, and subsequently the institution representative for endorsement, before it is delivered to the domain particular(prenominal) review board secretariat (National University Health System, 2010). All research studies submitted will be classified under one of the following review categories exempt review, expedited review, salutary Board review (see Appendix P) (National University Health System, 2010). Based on the definitions in Appendix P, this study is classified as an expedited review.Ethics approval for research is required for several reasons. Firstly, ethical norms promote the aims of research, much(prenominal) as knowledge, truth, and avoidance of error (Resnik, 2011).Secondly, ethical standards promote the values that are essential to collaborative work, such as trust, accountability, mutual respect, and fairness (Resnik, 2011). For example, guidelines for authorship, copyright and patenting policies, data sharing policies, and confidentiality rules in peer review, are designed to protect intellectual property interests while encouraging quislingism (Poortmans, 2013).Ethical norms in research also help to build public support for research as people are to a greater extent likely to shop research project if they can trust the quality and integrity of research (Resnik, 2011).Finally, many of the norms of research promote a variety of other important honorable and social values, such as social responsibility, human rights, compliance with the law, and health and safety. This also prot ect the rights and welfare of participants and minimise the risk of physical and mental vexation and harm from research procedures (Canterbury Christ Church University, 2006). Ethical lapses in research can strongly harm human subjects especially if the researcher fails to abide by the regulations and guidelines relating to radiation or biological safety (Resnik, 2011).Informed consent is the process by which the patient voluntarily confirms her willingness to participate in this research, after being informed of all the aspects of the research that are relevant to her decision-making (National Healthcare Group, 2013). The informed consent is documented by means of written signatures, date informed consent form and the language used during the explanation to the patient by the oncologist. In the consent, in that respect should be 3 signatures the patients, the doctors and the witness signature. For patients who cannot read and emit English, a qualified translator will be around during the signing of the consent.3.4 Research design and instrumentationThis research is a mixture of qualitative and numerical research methods (see Appendix Q). Quantitative research corresponds to a deductive scientific method of research which uses data in the form of numbers and statistics to test hypotheses, using a large and randomly selected sample that is a representative of the population (Pearce, et al. 2013 Johnson Christensen 2010).This is in contrast to the qualitative approach which corresponds to an inductive method of research which uses words, pictures or objects to examine a phenomenon, requiring only a small and non-randomly selected sample (Pearce, et al. 2013 Johnson Christensen 2010).Patients will be scanned using Toshiba Aquilion Large Bore CT-simulator (Toshiba, 2014). The treatment plans will be generated using Varian Medical Eclipse Treatment Planning System and patients will be tempered with DIBH technique using RPM from Varian Trilogy elongate accel erator (Varian Medical System, 1999-2014).3.5 data collection proceduresThe comparable radiation oncologist will perform all the delineation of the clinical target volume, the heart and LADCA for consistency purposes (see Appendix R). The delineation will be done according to radiation therapy oncology group (RTOG) breast contouring recommendations (Goksel, et al., 2013). Patients CT images at breath hold will be used to plan for DIBH technique while the one at free breathing will be planned for photon electron match technique. The treatments will be planned such that the clinical target volumes coverage of the dit distribution is kept between 90% and 110% of the prescribed dose. For each plan, heart and LADCA volumes were calculate in cm3. Dose volumes to the heart and LADCA will be normalized by dividing with the total organ volume. Heart and LADCA volumes receiving 5Gy to 50Gy (V5-V50) will be generated for comparison of treatment techniques. Dose distributions can be present ed as DVHs and representing the statistical dose distribution in a volume of interest. These statistical data will be record and presented in tables.Patient education is a very important component in DIBH technique using RPM to reduce anxiety and increase their confidence about receiving radiation therapy (Halkett Kristjanson, 2007). Patient education tools can be in many forms such as video or pamphlet (Halkett Kristjanson, 2007). For this research, a pamphlet have been created to improve patients on DIBH technique using RPM (see Appendix S). A qualitative research method such as face-to-face question is chosen to survey patients comfort and understanding at the middle of the treatment and on the last mean solar day of treatment as this only require the patients to discourse the same language in which the questions are asked, and to have basic verbal and listening skills (Bowling, 2009). The primary objective of this standardised and open-ended interview (Valenzuela Shrivas tava, n.d.) is to determine the head of understanding as well as patients comfort. The questions (see Appendix T) will be asked by the oncologist during the middle of the treatment and on the last day of treatment.The advantages of face-to-face interviews are that reading and writing skills are not required, interviewers are able to probe fully for responses and clarify any ambiguities, they can ask more complicated and detailed questions, and patients are able to clarify if they do not understand the questions (Bowling, 2009). This would be a better technique than self-administered questionnaires because pre-coded response choices may not be sufficiently comprehensive and patients may be forced to choose inappropriate pre-coded answers that might not fully represent their views (Bowling, 2009). This causes the data to be diverge as the patients replies are influenced by the design of the pre-coded response choices. Self-administered questionnaires also assumed that the questions are worded in a way that is understood by the patients (Bowling, 2009). Patients may misinterpret the questions and reply based on their own interpretation and questionnaires may be a problem for patients who are unable to read or write (Bowling, 2009). Most importantly, one-to-one interviews with standardised questions appeared to have the highest reliability (University of Leicester, n.d.).The radiation therapists workload will be thrifty in terms of training hours, and the comparison of treatment duration and manpower required for gated DIBH using RPM and photon electron match technique (see Appendix U) will be recorded and presented in charts.3.6 Data analysisPaired samples t-test will be used to determine whether there is a significant difference between the average dose to the heart and LADCA values made under photon electron match plan and gated DIBH using RPM plan (Norman Streiner, 2008). This is used because the data are measured at the scale level and the data are relat ed (Hawkins, 2009). The amount of radiation authentic by the heart can be recorded by comparability the DVHs of the photon electron match with gated DIBH using RPM. The statistical figures can be analysed using Statistical Package for Social Sciences (SPSS) (Yavas, et al., 2012). Paired samples t-test will be used to determine whether there is a significant difference between the average dose to the heart and LADCA values made under photon electron match plan and gated DIBH using RPM plan (Easton McColl, 2014). A p-value of Patients understanding and comfortThe questions (see Appendix T) from the standardised and open-ended interview were developed by a group of 2 radiation oncologists, a nurse and 2 radiation therapists. The areas of discussion were based on the groups clinical experience with left-sided breast cancer patients and their extensive knowledge on DIBH using RPM. The interview aims to determine the patients level of comfort and understanding of the gated DIBH using R PM. The design of the questionnaire will determine the reliability and validity of the opened-ended interview to measure patients level of comfort and understanding.Reliability is defined as the extent to which questionnaire will produce the same results on repeated trials (Miller, n.d.), and is measured by its equivalence and stability. Equivalence reliability assesses the consistency of the judgement of the patients answer by the interview (Miller, n.d.). It is improve by pre-empting a range of responses that might be given by the patients and give a pre-determined rating to each response so that the interviewers will have the same level of judgement (Miller, n.d.). For example, _____________-Stability reliability is correlated to the repeatability of the patients response under the same conditions after a period of time (Miller, n.d.). For this interview, the patients will be interviewed twice, once during mid-treatment and the other on the last day of their treatment. Their res ponses from both sessions will be compared to determine if there are any deviance. This assumes that the characteristics that is measured doesnt change with time, and that the time period is long enough that the memories from the 1st interview will not influence the responses of the 2nd interview (Miller, n.d.).The validity of the interview is the extent to which the interview questions measures what it purport to measure, and it generally takes the form of content validity (Miller, n.d.). Content validity is the degree to which the questions fully assess or measure the excogitation of the interview (Miller, n.d.). This was determined by letting the team review the individual questions for readability, clarity and comprehensiveness and come to some level of agreement as to which items should be included in the final interview questions. The interview questions (see Appendix T) were reviewed and accepted by the team prior to the conduct of the interview.The treatment duration will b e recorded as seen in Appendix U and a paired samples t-test similar to appendix V will be used to determine whether there is a significant difference, where the null hypothesis (H0) is there is no difference between the treatment time with photon electron match technique and DIBH using RPM technique.The radiation therapist workload will be analysed based on the minimum number of manpower required for gated DIBH using RPM as compared to photon electron match technique and in terms of training hours. This will be discussed among the radiation therapists and presented in charts.3.7 LimitationThis research can only sample from a small size due to constraint of resources where there is only 1 treatment unit that has the RPM equipment required for DIBH technique. The expected sample size calculated is only an estimate as the treatment difference and standard deviation are never known in advance (Norman Streiner, 2008). As such, the actual sample size may be slightly smaller than 68.3.8 Expected ResultsThe results from this research are expected to show optimal radiation exposure volumes and doses for the heart and LADCA when treated with gated DIBH using RPM compared to photon electron match technique at free breathing. These results are expected to be compatible with findings from previous studies (Pedersen, et al., 2004 Korreman, et al., 2005 Shim, et al., 2012 Mast, et al., 2013). As such, showing that patients with left sided breast cancer will benefit from gated DIBH using RPM. Treatment time duration for gated DIBH using RPM is expected to have a significant difference and be faster than photon electron match technique. As gated DIBH using RPM is new to the radiation therapists, the workload is expected to be heavier in the beginning.3.9 Budget on that point will be no additional cost for this research as the RPM equipment is already available together with the linear accelerator from Varian (Varian Medical System, 1999-2014). in that location will be no co st for training on the usage for RPM by Varian as it was included in the package when the linear accelerators were bought in 2013. Patients recruited for this research will be charged the same cost as photon electron match treatment technique.3.10 Expected TimelineThis research aims to commence from January 2015 till declination 2015. The work plan for both the principal investigator and research assistants can be seen in Appendix W.Chapter IV ConclusionThis research aims to review gated DIBH using RPM as a treatment technique for left-sided breast cancer patients as compared to photon electron match in terms of the radiation dose received by the heart and LADCA. Paired t-test is chosen to measure the significant difference between the dose received by the heart in photon electron match technique and DIBH using RPM technique. Based on literatures that were review, the results are expected to be in favour of gated DIBH using RPM. Interviews will be conducted to assess patients comfo rt and understanding about gated DIBH using RPM. And data collection will be done gauge the workload of the radiation therapist. The results from interview and data collection will allow us to gauge further if it is really practical to implement gated DIBH using RPM in our department. If the results are clinically significant and positive, gated DIBH using RPM will be implemented into our department.4.1 RecommendationFor future recommendation to try contrast-enhanced CT scan in left-sided breast patients so that the LADCA can be seen clearly in the scan and able to be delineated by the doctor effectively (Yu, et al., 2013). This is to increase the accuracy of the delineation of LADCA as well as the accurate amount of radiation dose received by it. After this research, another study can be done in the future on the reproducibility of patients breath holding level for every fraction using a cine acquisition mode (CAM) of a linear accelerator during treatment (Goksel, et al., 2013).

Understanding Peer Pressure Essay -- Peer Pressure Essays

As you grow older, youll be faced with some challenging decisions. Some dont have a clear right or wrong answer. Other decisions involve serious moral questions. Making decisions on your own is hard enough, but when other people sterilise involved and deform to pressure you one way or another it dismiss be nevertheless harder. People who are your age, like your classmates, are called peers. When they try to influence how you act, to get you to do something, its called peer pressure. Its something everyone has to deal with, even adults. Maybe you want to do it, and you just dont have the courage to do it and your friends talk you into it. Peer Pressure commode be broken down into two areas, good peer pressure and bad peer pressure. When we think of peer pressure we always think of it in terms of bad. We think of peer pressure in terms of pressuring others into, smoking, do illegal drugs, drink alcohol, have promiscuous sex, engage in criminal and quasi-criminal, behavior, do vio lence, join gangs, and so on. We rarely think of the many good ways that peer pressure can influence us and neither do the parents of teens. It is stout to be the only one who says no to peer pressure, but you can do it. Paying attention to your own feelings and beliefs about what is right and wrong can help you know the right thing to do. Inner strength and self-confidence can help you stand firm, walk away, and resist doing something when you know better. Peers influence your life, even if you don...

November Rain :: English Literature Essays

November fallI pass a shop display and view my reflection in the glass-a tumesce built humans of thirty with a tanned complexion, dark eyes and hair. I seem to have a certain charm and grace that can-and does-go down very well with the ladies. I open the door, pull out the chair, buy the drinks and surprise them with gifts. I stay at their flats after a night out I chair my belongings there. You could say that Im just a bachelor with a lust for living-if I wasnt married.Ive been married hug drug historic period and it feels like 40. It was great at first-nights out in clubs, at parties, flirting, teasing and loving each other, or at least touching each other. We had no children to take prisoner us down and a whole world of fun to experience. Then, it stopped. I cant remember when, where or how. What I know is that for ten years Ive been bound to this woman and all the practices of such a colourful marriage have been tried and are jaded the feelings no monthlong evident. She i s abrupt with her answers and retorts for the most part and otherwise silent, so we both have seemed to have taken our own practices elsewhere, fallen into another persons weaponry and experience the same feelings anew.I walk on by, get into my shining convertible (which is now speckled with signs of yet more rain) and speed away. I look into the hall of my home in Chicago, Illinois, and into the kitchen. Rain cascades down the windowpane, such has been the case for much of Novmber. There is a plate of spaghetti Bolognese waiting right on the counter for me. I heat it up, and take it to my study, letting the aroma waft right past my nose. Turning on the stereo, I settle back in my leather, over-cushioned armchair with a long, relaxed sigh. The stereo always starts on Classic Rock radio station. Hard rock, thats what I love best. I open the Wall route Journal, sub-consciously listening to the music in the background. Bliss.Blackwater shares have(Music in background)When I look into your eyes, I can see a love restrained, but darlin when I hold you, dont you know I feel the sameI look up to see the source of this slightly familiar song November Rain by Guns N Roses.both know hearts can change, and its hard to hold a candle in the cold November rain

Karl Marx and Capitalist Alienation Essay -- Alienation Marxism Marxis

The concept of madness plays a significant map in Marxs early political writing, especially in the Economic and Philosophical Manuscripts of 1848, but it is seldom mentioned in his later works. This implies that while Marx found alienation serviceable in investigating certain basic aspects of the development of capitalist confederacy, it is less useful in targetting forward the predictions of the collapse of capitalism. The aim of this essay is to explicate alienation, and show how it fits into the pattern of Marxs thought. It will be concluded that alienation is a useful gibe in explaining the affect of capitalism on hu piece of music existence. In Marxs thought, however, the usefulness of alienation it is limited to explanation. It does not help in either predicting the downfall of capitalism, or the creation of communism.Marx takes his idea of alienation from Feuerbach, who shows the alienation of art object from God. Briefly, Feuerbachs controversy is that God is created by gentlemans gentleman as the projection of mans species-essence, the totality of his powers and attributes raised to the level of infinity (1). Religion alienates man by reversing the relationship between the subject and predicate - the deity is supreme over man, even though it is created by man. Leszek Kolakowski suggests that the clearest material example of religious alienation is blood sacrifice. In general, therefore, alienation of man is the process that separates man from part of himself. In Feuerbach, the separation is between man and the god created in mans image. In Marx, as shall be seen, alienation is the separation between man and his life-activity, his product, society and the species. Each of these four relations can be seen as one aspect of man being separated from himself.... ...(rather than local) being. (13) Thus, although alienation take into accounts an understanding of the problems of capitalism, it does not provide a means of escaping it.1. L. Kolakowsk i, Main Currents of Marxism, pp 115.2. L. Kolakowski, Main Currents of Marxism, pp 115.3. B. Ollman, Alienation, pp 133. 4. S. Avineri, Karl Marx Social and Political Thought. 5. This point is also put forward by Herbert Marcuse. 6. L. Kolakowski, Main Currents of Marxism. 7. K. Marx, Economic and Philosophical Manuscripts. 8. B. Ollman, Alienation, pp131. 9. G. A. Cohen, Karl Marxs hypothesis of History A defence. 10. H. Marcuse, Reason and Revolution. 11. K. Marx, Economic and Philosophical Manuscripts. 12. B. Ollman, Alienation, pp138. 13. Spiritual in the sense of gentle fulfilment in work, rather than any religious sense. 14. K. Marx, The German Ideology, pp56. Karl Marx and Capitalist Alienation Essay -- Alienation Marxism MarxisThe concept of alienation plays a significant role in Marxs early political writing, especially in the Economic and Philosophical Manuscripts of 1848, but it is rarely mentioned in his later works. This implies that while Marx found alienation useful in investigating certain basic aspects of the development of capitalist society, it is less useful in putting forward the predictions of the collapse of capitalism. The aim of this essay is to explain alienation, and show how it fits into the pattern of Marxs thought. It will be concluded that alienation is a useful tool in explaining the affect of capitalism on human existence. In Marxs thought, however, the usefulness of alienation it is limited to explanation. It does not help in either predicting the downfall of capitalism, or the creation of communism.Marx takes his idea of alienation from Feuerbach, who shows the alienation of man from God. Briefly, Feuerbachs argument is that God is created by man as the projection of mans species-essence, the totality of his powers and attributes raised to the level of infinity (1). Religion alienates man by reversing the relationship between the subject and predicate - the Deity is supreme over man, even though it is creat ed by man. Leszek Kolakowski suggests that the clearest material example of religious alienation is blood sacrifice. In general, therefore, alienation of man is the process that separates man from part of himself. In Feuerbach, the separation is between man and the god created in mans image. In Marx, as shall be seen, alienation is the separation between man and his life-activity, his product, society and the species. Each of these four relations can be seen as one aspect of man being separated from himself.... ...(rather than local) being. (13) Thus, although alienation provides an understanding of the problems of capitalism, it does not provide a means of escaping it.1. L. Kolakowski, Main Currents of Marxism, pp 115.2. L. Kolakowski, Main Currents of Marxism, pp 115.3. B. Ollman, Alienation, pp 133. 4. S. Avineri, Karl Marx Social and Political Thought. 5. This point is also put forward by Herbert Marcuse. 6. L. Kolakowski, Main Currents of Marxism. 7. K. Marx, Economic and Phil osophical Manuscripts. 8. B. Ollman, Alienation, pp131. 9. G. A. Cohen, Karl Marxs Theory of History A defence. 10. H. Marcuse, Reason and Revolution. 11. K. Marx, Economic and Philosophical Manuscripts. 12. B. Ollman, Alienation, pp138. 13. Spiritual in the sense of human fulfilment in work, rather than any religious sense. 14. K. Marx, The German Ideology, pp56.

William Shakespeares Sonnet 18 Essay examples -- Shakespeare Sonnet

Keeping turn in alive is not easy. One knows that life eventually comes to an end, but does bask? succession passes and days must end. It is in praise 18, by Shakespeare, that we see a challenge to the idea that complete is finite. Shakespeare shows us how some love is stark(a) and will live on forever in comparison to a beautiful summers day. Shakespeare has a way of keeping love alive in Sonnet 18, and he uses a variety of techniques to demonstrate how love is more brilliant and everlasting than a summers day.The first technique Shakespeare uses to demonstrate everlasting love is to ask the question Shall I compare thee to a summers day? (1) This leads the reader to consider other questions. Is love as bright and beautiful as a summers day? Is the person the speaker is admiring as lovely and as kind as a summers day? These questions are answered in the second line with railway yard art more lovely and more temperate. This shows that the person the speaker is admiring is more beautiful, calm and understanding than a summers day. The summer is inferior to the person being admired, and the speakers love for this person is everlasting.If anyone has every experienced a beautiful summers day he or she will see that the trees will shake from the wind. Leaves do eventually worsening from the once lively buds of spring. Shakespeare also uses the technique of imagery to develop his idea of love in line three Rough winds do shake the pricey buds of May. With this Shakespeare is telling us that though the winds of a summer shake the trees beauty, it will not shake the internal feelings of love from the speaker. Summer days are special they are short and soon will come to an end. Every year summer ends. Yes, it may begin again next year bu... ...agree with the sonnet and its last-place couplet. This structure, along with the iambic pentameters stressed and unstressed syllables engage the reader on the argument Shakespeare reaches for everlasting love. he struc ture of a Shakespearian sonnet support in the emphasis of everlasting love. This also provides the reader to correctly read the sonnet as Shakespeare intended. Shakespeare has chosen the sonnet forms to develop his idea of everlasting love with questions, imagery, metaphors, rhyme schemes, and structure. Without these techniques we would not be able to gain the correct perspective that the beauty of love prevails over the beauty of nature also how nature is not permanent and the sonnet will be everlasting.Works CitedShakespeare, William. Sonnet 18. Introduction to literature. Ed. Isobel M Findlay et al. 5th ed. Canada Thomson Nelson, 2004. 133-134.

Analyse The Streingths and Weaknesses Of The Boston Matrix As An Aid T

In this essay I will look at the strengths and weaknesses of using the capital of Massachusetts Matrix to help make decisions in business. I will first briefly explain the Boston Matrix and then analyse its effectiveness as an aid to making a commercialiseing strategy.Like Ansoffs matrix, the Boston Matrix is a well known tool for marketplaceingmanagers. It was developed by the full-grown US consulting group and is a way that a business can compare all of its products. The two aspects it looks at are market share (relative to that of competitors) and market growth. To use it you would look at all of your products and sort them into 4 categories, stars (products with a high market growth and a high market share), money awe (high market share in a market with little growth), problem children/question marks (low market share in a growing market) and dogs (low market share in a market with no growth). There needs to be an equilibrium of the different types in your product portfolio . Never have either dogs, but try and keep the same amount of the other 3 types. This means that funds can be evenly distributed between the 3, money generated from cash cows needs to be spent turning problem children into stars, which will eventually contract cash cows, and the cycle continues. Some problem children will become dogs, and money from cash cows may also have to be spent compensating for these failures.The Boston Matrix is commonly used to try and help purpose the future of a company as well as simply categorising products. Bu...